PO BOX 1596 New York NY 10025

1-888-90-WELLS or 212-222-9177

O r d e r  f o r m

Name____________________________________________   Address__________________________________________  _________________________________________________ City ______________________State______Zip___________ Daytime Phone_____________________________________  Evening Phone_____________________________________

Payment Method - DO NOT SEND CASH    Please make check or money order payable to: Wells Jenkins  Money Order Enclosed Check Enclosed  Visa    Master Card        American Express Credit Card No. Exp. Date (mm/yy)  /  No Refunds on Custom Orders Customer Signature________________________________

Item #	Description	# Of Photos Sub- mitted	Loose or Fixed L or F	Size/ shape/ Color BW/C/Sep	Gift Box? Y or N	Ornament Ribbon Choice	Ornament Charm Choice	Quan- tity	Price
Shipping Chart If order total is: Add:  Under $40  $4.95  $40 - $59  $7.95  $60 - $79  $8.95  $80 - $99  $9.95  $100 - $149  $11.95  $150 - $199 $12.95  Over $200 $13.95  Special Instructions:  NO REFUNDS on custom orders.							Total Price of items
							Shipping (See Chart)
							Alaska, Hawaii add $10
							Express Mail add $10
							Gift Box Add $2ea.
							In NY add 8.625% sales tax
							Total